What do I need to know about sleep?

Sleep is a natural process that allows the brain and body to rest and recover. When you are asleep, your eyes are closed, most of your muscles are relaxed, and your consciousness is practically suspended. But while your body is still, your brain is quite active.

Sleep is important as it helps us restore and recover ourselves physically while also assisting us to organise things in our brain. People need sleep in order to function well – mentally and physically.

Going without sleep or having insufficient sleep can lead to a range of issues including:

• Poor mood / feelings of depression
• Lack of concentration
• Irritability
• Low motivation
• Heart disease
• Blood pressure
• Diabetes
• Increased likelihood of road accidents or workplace accidents

Sleep can be affected by a range of things including ageing, lifestyle commitments, injury, trauma, stressors, health problems, anxiety, depression, medication.
However a regular sleep pattern CAN be re-established after a disruption, even a significant disruption.

Sleep cycle
Sleep occurs in cycles that last around 90 minutes per cycle. During each cycle, different types of brain activity occur.
5 stages of sleep have been identified based on this brainwave activity:

Stage 1: Drowsiness. This is often referred to as the transition between awake and asleep. The eyes are generally closed, but the person awakens easily. If disrupted during this period, people will often state that they were not yet asleep or were just resting. This usually lasts for around 5-10 minutes
Stage 2: Light sleep. This sleep stage involves spontaneous periods of muscle activity mixed with periods of muscle relaxation. The heart rate slows and body temperature decreases. The body prepares to enter deep sleep.
Stages 3 and 4: Deep Sleep. Also known as slow-wave or delta sleep. During these stages the breathing is more relaxed, heart rate slows, sound and light sensitivity diminish. It is difficult to wake someone while in a deep sleep. Quality sleep needs to include deep sleep. Often when people seem to have had sufficient sleep (as measured by hours of sleep) but are still tired and fatigued each morning, it may be that they are not achieving deep sleep in their cycle. This deep sleep is vital in the secretion of the growth hormone. This hormone is necessary to restore the body and if this does not occur, people can be more prone to infections and disease. Alcohol, medication and stress can all impact on your ability to achieve deep sleep.
Stage 5: REM (Rapid Eye Movement) sleep. Also known as dream sleep. During REM sleep there is heightened brain activity, but the mind paralyses the muscles, possibly to keep the body from acting out the dreams and harming itself. The first period of REM typically lasts around 1 minutes, with each recurring REM stage becoming longer. The final stage may last around an hour. REM sleep is vital for normalising cognitive and emotional activities.

How much sleep do we need?
Different people require different amounts of sleep, which changes over a person’s life span. The average for an adult is around 7-8 hours, but anything within 5–10 hours can be normal.
The best guide to whether you are having enough sleep is how you function throughout the day. If you are sleepy and struggle to concentrate it is likely you are not getting enough sleep.

The first 3-5 hours of sleep is when the deepest sleep occurs (see graph above). This is the most restorative.

Waking up a few times during the night is quite normal and nothing to be concerned about. This usually occurs during the periods of light or REM sleep spaced out over the night. Being concerned or worried about waking up generally increases the likelihood of it being difficult to get back to sleep and increase these awake periods.

Sleep deprivation Scale

The Epworth Sleepiness Scale (ESS) can provide a measure of the impact of sleep deprivation on daytime function. This should only be used by people not on sleep medication.

If you feel you may be deprived of sleep and are not taking any sleep medication, completing this quick scale can give you an indication of how much impact it is having on your life:

0 would never doze
1 slight chance of dozing
2 moderate chance of dozing
3 high chance of dozing

Situation                                                                                           Rating
Sitting and reading                                                                        ______
Watching TV                                                                                   ______
Sitting inactive in a public place (e.g. movie or meeting)      ______
Passenger in a car for 1 hour with no break                              ______
Lying down in the afternoon when circumstances permit     ______
Sitting and talking to someone                                                    ______
Sitting quietly after a lunch without alcohol                             ______
In a car, while stopped for a few minutes in traffic                  ______
TOTAL ______

Score indicator:
0-4 Satisfactory daytime functioning
5-9 Daytime tiredness, lack of energy
>10 Excessive daytime sleepiness

Sleep Diary
If you feel you have an issue with sleep or score 5 or above on the Epworth scale, the first step in making change can be to record relevant information in a sleep diary for 4-5 days in a row. This should give a clear indication of a baseline pattern and can identify potential problem areas and solutions.

Each day record:
• any daytime naps and their duration
• number of cups of tea, coffee, cola or energy drinks and approx. time each one was consumed
• number of standard drinks of alcohol and approx. time of consumption
• any sleep medication and time taken
• time when you go to bed
• approx. time when you fall asleep
• number of times you wake through the night and approx. indication of how long you were awake for
• time when you wake
• time when you got out of bed
It is important not to be too obsessed with clock watching or it will interfere with your natural pattern. This is particularly the case when waking in the night – clock watching will only increase the time you are awake for. An estimate of your sleep behaviours is fine.

Creating Positive Change

People who are having difficulties with sleep during the night often try to go to bed earlier or stay in bed longer to “catch up” on their sleep. This generally makes the problem worse, as more time is spent lying in bed awake. Often people feel anxious or frustrated about not sleeping during this time, which can build up an association between being in bed and negative emotions.

It is not necessarily easy to re-set your sleep pattern. It needs commitment and persistence. Initially you are likely to feel tired and irritable and may even get less sleep as your body adjusts to a new pattern. You will often feel more tired during the day, but it is important not to nap until the pattern is established.

Be aware it may take from 4-6 weeks to notice any improvement - repetition and consistency is key.

Effective Strategies:

• The most effective strategy when re-introducing a sleep pattern is ensuring a regular wake-up time. Stick to this wake-up time 7 days per week, even if you feel you haven’t had much sleep during the night.
• Get sunlight within 10-15 minutes of waking if possible.
• Only go to bed when you feel sleepy rather than at a fixed time in the evening.
• Establish a regular evening sleep routine – this is a pattern of behaviour that tells your body and mind it is time to go to sleep.
• Only stay in bed if you are sleeping. If you are lying in bed awake for more than 20 minutes, get up and do something relaxing in another room until you feel tired again.
• Only use the bed/bedroom for sleep or sexual intimacy. Avoid laying in the bed to rest during the day or using the bedroom to watch TV, eat, smoke, work, play computer games or chat on your phone.
• Avoid taking daytime naps.

During the Day:
• Keep a regular routine for meals, medication and general daily activities
• Pace your activities throughout your day
• Spend time outdoors in the afternoon if possible
• Avoid napping
• Keep as active as possible
• Reduce coffee to no more than 3 cups per day

During the evening:
• Relax and prepare for sleep
• Utilise an hour of quiet activity before you intend to sleep
• List what is on your mind and organise to do it tomorrow (to avoid worrying or planning throughout the night)
• Learn and use a relaxation tool to switch off. This may be a breathing exercise, mindfulness, meditation, or something that works for you.
• Avoid exercise late in the evening – light exercises early in the evening can be helpful
• Avoid caffeine for at least 5 hours before bedtime
• Avoid smoking before bedtime and during wakening
• Avoid alcohol near bedtime
• Avoid a heavy meal too close to bedtime
• Reduce disturbing noises and be calm about the unavoidable
• Avoid screentime – particularly laptops and mobile phones for one hour before bed

At bedtime:
• Develop a bedtime routine and follow it every night
• Recognise any emotional responses for what they are and use appropriate coping techniques to deal with such responses
• Only go to bed when you feel ‘sleepy tired’, not when you are just physically exhausted or you think its time for bed
• Keep reading and TV for another room
• Avoid using your bed for anything other than sleep or sexual intimacy
• Do not lie in bed awake for longer than 15-20 minutes
• During that 15-20 minutes enjoy relaxing in bed if you do not fall straight to sleep
• Use relaxation techniques to induce sleep
• Prepare somewhere to go (e.g. another room) and something to do if you do have to get up
• Return to bed only when you feel sleepy again
• Repeat the rising routine as frequently as necessary
• Keep the bedroom dark

When getting up in the morning:
• Get up at the same time each morning
• Have a routine that refreshes and takes your needs into account
• Allow time to avoid demanding morning routines
• Make a plan for the day
• Ensure that you have at least one rewarding activity.

Important tips when trying these strategies:
• Rather than being discouraged if there are lots of things you have identified that you can change, be pleased that you have identified a number of things that can help as this increases your chance for improvement.
• Don’t expect to have great results overnight – improvement may take 4-6 weeks.
• Change can take longer if the reasons for the sleep disruption are more complex. Be patient with yourself and take things one step at a time.
• It can be helpful in the initial stages to focus on behaviours/strategies you can ADD rather than things you need to avoid or stop doing.
• Feeling tired throughout this process of change is totally normal – feeling sleepy during the day is often one of the last things to disappear.
• A habit is learned and established by consistent repetition over long periods of time – it might be hard, but don’t give up!

SUMMARY: Tips to Sleep Better
• Stick to a consistent wake up time – even on the weekends. This helps to regulate your body’s clock and could help you fall asleep and stay asleep for the night.
• Practice a relaxing bedtime ritual. A relaxing routine activity right before bedtime conducted away from bright lights helps separate your sleep time from activities that can cause excitement, stress or anxiety.
• Avoid daytime naps – particularly in the afternoon. Power napping may help you get through the day, but if you find that you can’t fall asleep at bedtime, eliminating even short catnaps may help.
• Exercise daily. Vigorous exercise is best, but even light exercise is better than no activity. Exercise at any time of day, but it is best to avoid vigorous exercise for a few hours before bedtime.
• Avoid alcohol, caffeine, cigarettes and heavy meals in the evening. You may feel that alcohol or heavy meals make you tired enough to fall asleep, but these can interrupt with the natural sleep cycle and may lead to waking early or not getting sufficient deep sleep.
• Wind down – Your body needs time to shift into sleep mode, so spend the last hour before bed doing a calming activity such as reading, talking, or listening to music. For some people using an electronic device such as a laptop or phone can make I hard to fall asleep because the particular type of light coming from the screens is activating to the brain. If there are any activities that you associate with anxiety about sleeping, remove them from your bedtime routine.
• Evaluate your room. Design your sleep environment to establish the conditions you need for sleep. Your bedroom should be on the cooler side (around 15-19 degrees). It should also be free from any noise and light that can disturb your sleep. If you have environmental distractions you can’t remove, try using eye shades, ear plugs, white noise machines, or other devices.
• Sleep on a comfortable mattress and pillows – Make sure your mattress and pillow is comfortable and supportive.
• If you can’t sleep, don’t just lay there – go into another room and do something relaxing until you feel tired.
• Use your bed only for sleep and sex to strengthen the association between bed and sleep.

 

Our Rehabilitation Counsellors can help you to implement these strategies and improve your sleep health. Contact us today for more information if you need additional assistance. 

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